New Client Information Form

Telephone
905-934-0966
Send us an Email
Quick Order Form

To get started with H2Only, please fill out this form. We will be in touch with you shortly afterwards!

Thank you for considering H2Only for your bottled water needs!

Please take a few moments to fill out the form below.

Contact Information
	Outlined fields are required
First Name
Last Name
Company Name	If applicable
Phone Number
Email Address
Delivery Address
Street Address
Unit Number
City
Postal Code
Product Required
Bottle Size
Number of bottles
Need a cooler / dispensor?	Check for 'yes'. Don't worry. When we connect we'll sort it out!
Instructions / Questions

Middle Initial

Important: If we do not confirm your form submission within 12 hours Sunday-Thursday or within 24 hours Friday and Saturday, we almost certainly did not receive your order. If that is the case, please call the office at 905-934-0966

Thank you for considering H2Only for your bottled water needs!

pure reverse osmosis bottled water delivery service to your home and workplace in the niagara region